Prevention of sports-related sudden cardiac death Preparticipation screening of elite and recreational athletes

Regular physical activity is associated with appreciable cardiovascular benefits but, paradoxically, vigorous exertion increases the risk of sudden cardiac death (SCD) in athletes by 2to 3-fold compared with nonathletes. The exact incidence of sports-related SCD remains unclear owing to differing methodology and heterogeneous population comparisons. Younger athletes are most commonly affected by underlying inherited/congenital cardiac disease whereas in older athletes aged >35 years coronary artery disease (CAD) predominates by far. However, different regional distribution patterns of cardiac diseases as a result of heterogeneous ethnic population compositions have to be taken into account. Preparticipation Screening with personal/family history, physical examination and resting electrocardiogram has the potential to detect many causes of SCD, which reduces its incidence. However, in older athletes, this screening modality is of limited value because of the high prevalence of CAD. Therefore, an individualised screening approach is adopted for athletes aged >35 years according to their risk profile and the intended level of physical activity. As cardiovascular screening cannot detect all individuals at risk, particular focus should be put upon secondary prevention measures, including education about adequate cardiopulmonary resuscitation and availability of automated external defibrillators at sporting facilities. In this review, we summarise the current state of knowledge of SCD in athletes of different age groups with regard to epidemiology. Furthermore, we discuss primary and secondary prevention strategies such as cardiovascular screening recommendations and on-site prevention.